Following the writing of the Maternal Care and Newborn Care manuals, it was important to assess whether the PEP course was acceptable to health care workers and whether it improved the standard of their knowledge, skills, attitudes and care in South Africa. The impact of the PEP course was initially evaluated in a pilot trial. This was followed by two prospective controlled intervention studies.

PILOT TRIAL

A pilot study between 1991 and 1993 was conducted in district, regional and tertiary hospitals in the Western and Eastern Cape and Gauteng Provinces of South Africa. In all sites, the theoretical knowledge of maternal and newborn care improved significantly (p<0,01) when PEP was used by groups of midwives to manage their own training courses (see reference 2).

STUDY OF THE MATERNAL CARE MANUAL

Professor Gerhard Theron (Department of Obstetrics and Gynaecology, University of Stellenbosch) introduced the Maternal Care manual to midwives in Grahamstown. The midwives managed their own course. The neighbouring towns of Cradock and Somerset East were used as control sites where the manual was not used. The knowledge, clinical skills, attitudes and standard of patient care of the midwives in both the study and control towns were formally assessed at the start and end of the trial (see references 4-8). Theoretical knowledge, practical skills, attitudes and patient care practices improved significantly in the intervention towns (p<0,01) but not in the control towns.

STUDY OF THE NEWBORN CARE MANUAL

Dr David Greenfield (School of Child and Adolescent Health, University of Cape Town) conducted a similarly designed study using the Newborn Care manual at the Uitenhage Provincial Hospital with the Dora Nginza Hospital in Port Elizabeth as the control site (see reference 11). He showed that neonatal nurses in the study hospital significantly (p<0,01) improved their knowledge, clinical skills and patient care practices. There were no significant changes in the control hospital.

STUDY OF THE PERINATAL HIV/AIDS MANUAL

The Perinatal HIV/AIDS manual was assessed in a small field trail in Kwazulu/Natal. This study documented a significant (p<0,01) improvement in theoretical knowledge when midwives managed their own courses (see reference 12).

PERSONAL COMMENTS

Most participants of the PEP course reported that they found this learning method simple, easy and enjoyable. They felt more confident of their knowledge and skills, less stressed at work and happier that they were providing a better service to their patients. Many nurses expressed a wish that their medical colleagues should also use the PEP manuals. Medical students have enjoyed the PEP manuals which have helped prepare them for community service.